1
|
Donbaloğlu Z, Barsal Çetiner E, İnan Yüksel A, Singin B, Aydın Behram B, Bedel A, Parlak M, Tuhan H. Sleep disturbances in children and adolescents with type 1 diabetes mellitus: Prevalence, and relationship with diabetes management. Sleep Med 2024; 115:55-60. [PMID: 38330696 DOI: 10.1016/j.sleep.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE A decline in sleep quality and regularity has been reported in patients with type 1 diabetes mellitus (T1D) in many studies. However, research on medical-based sleep disorders in patients with T1D is limited. Diagnosing sleep disorders is crucial, as it negatively impacts academic performance, cardiovascular health, and cognitive functions among children as well as essential skills for effective diabetes management. Our objective was to assess sleep disturbances in patients diagnosed with T1D and explore whether these patients experience significantly more sleep disturbances compared to their healthy peers. METHODS This study, designed as a cross-sectional case-control investigation, involved a cohort of 250 participants (144 T1D, 106 control cases) aged 6-15 years. The Sleep Disturbance Scale for Children (SDCS) scores of the T1D group were compared with those of the control group. Furthermore, the study explored the correlation between clinical/biochemical parameters and SDCS scores within the T1D group. RESULTS The mean age of individuals in the T1D group was 10.27 ± 3.25 years, while the control group had a comparable mean age of 10.48 ± 3.5 years (P = 0.303). Within the T1D group, the median duration of diabetes was 5 (1-15) years, and the median glycosylated hemoglobin A1c (HbA1c) level for the past one year was 8.4 %. Although there was no significant difference in total SDSC scores between the T1D and control groups, both groups exhibited average scores that remained close to the threshold indicative of sleep disturbances (>39). Notably, individuals with total SDSC scores surpassing 39 were identified at rates of 48.6 % in the T1D group and 47.6 % in the control group, respectively. Furthermore, disorders of arousal nightmares (DA) were more prevalent in T1D patients compared to their healthy peers (P = 0.049). Additionally, HbA1c showed a positive correlation with scores for disorders of excessive somnolence (DOES) and total scores (P < 0.001, R = 0.368; P = 0.003, R = 0.243). CONCLUSION Our study found that the prevalence of sleep disturbances among children and adolescents with T1D was not significantly higher than that observed in their healthy peers. Nevertheless, it is crucial to note that a notable portion, 48.6 % of T1D cases and 47.6 % of healthy cases, displayed sleep disturbances based on SDSC scores. To optimize diabetes management and proactively address potential challenges, incorporating routine screening for sleep disturbances in the monitoring of T1D patients can yield valuable benefits.
Collapse
Affiliation(s)
- Zeynep Donbaloğlu
- Department of Pediatric Endocrinology, Akdeniz University Hospital, Antalya, Turkey
| | - Ebru Barsal Çetiner
- Department of Pediatric Endocrinology, Akdeniz University Hospital, Antalya, Turkey
| | - Aynur İnan Yüksel
- Department of Pediatrics, Akdeniz University Hospital, Antalya, Turkey
| | - Berna Singin
- Department of Pediatric Endocrinology, Akdeniz University Hospital, Antalya, Turkey
| | - Bilge Aydın Behram
- Department of Pediatric Endocrinology, Akdeniz University Hospital, Antalya, Turkey
| | - Aynur Bedel
- Department of Pediatric Endocrinology, Akdeniz University Hospital, Antalya, Turkey
| | - Mesut Parlak
- Department of Pediatric Endocrinology, Akdeniz University Hospital, Antalya, Turkey
| | - Hale Tuhan
- Department of Pediatric Endocrinology, Akdeniz University Hospital, Antalya, Turkey.
| |
Collapse
|
2
|
İpar N, Boran P, Barış HE, Us MC, Aygün B, Haliloğlu B, Gökçe T, Can E, Eviz E, İnan NG, Mutlu GY, Bereket A, Hatun Ş. Associations between sleep characteristics and glycemic variability in youth with type 1 diabetes. Sleep Med 2023; 109:132-142. [PMID: 37437493 DOI: 10.1016/j.sleep.2023.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/15/2023] [Accepted: 06/18/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE This study aimed to determine sleep characteristics and their associations with glycemic variability in youth with type 1 diabetes (T1D). MATERIAL AND METHODS This cross-sectional study conducted at two pediatric diabetes centers in Istanbul, Turkey, included 84 children with T1D (mean age 10.5 years). Sleep characteristics and glycemic variability were determined by actigraphy, DSM-5 Level 2-Sleep Disturbance Scale Short Form and continuous glucose monitoring. Circadian preference was evaluated by the Children's Chronotype Questionnaire. Sleep disturbances were assessed by the. The sleep quality was determined by actigraphy-derived sleep measures. RESULTS Eighty-eight percent of participants had insufficient age-appropriate total sleep time (TST) (<9 h for 6-13-year-olds and <8 h for 14-17-year-olds). Chronotype was classified as intermediate in 50%, evening in 45.2%, and morning in 4.8%. A higher chronotype score indicating a stronger eveningness preference was associated with more time spent in hypoglycemia (β = 0.433, p = 0.002). On nights when participants had lower sleep efficiency and longer sleep onset latency, they had significantly higher overnight glycemic variability (β = -0.343, p = 0.016, β = 0.129, p = 0.017, respectively). Prolonged nocturnal wake duration was significantly associated with more time spent in daytime hypoglycemia (β = 0.037, p = 0.046) and higher overnight glycemic variability (J index, β = 0.300, p = 0.015). The associations between TST and glycemic variability indices were not significant. CONCLUSIONS Sleep quality rather than TST was significantly associated with glycemic variability in children with T1D. Eveningness preference might contribute to an increased risk of hypoglycemia. Addressing sleep patterns and chronotypes can be crucial in management plans for youth with T1D.
Collapse
Affiliation(s)
- Necla İpar
- Institute of Health Sciences, Social Pediatrics PhD Program, Marmara University, Istanbul, Turkey; Department of Pediatrics, Koc University School of Medicine, Istanbul, Turkey.
| | - Perran Boran
- Institute of Health Sciences, Social Pediatrics PhD Program, Marmara University, Istanbul, Turkey; Department of Pediatrics, Division of Social Pediatrics, Marmara University School of Medicine, Istanbul, Turkey.
| | - Hatice Ezgi Barış
- Institute of Health Sciences, Social Pediatrics PhD Program, Marmara University, Istanbul, Turkey; Department of Pediatrics, Division of Social Pediatrics, Marmara University School of Medicine, Istanbul, Turkey.
| | - Mahmut Caner Us
- Institute of Health Sciences, Social Pediatrics PhD Program, Marmara University, Istanbul, Turkey.
| | - Burcu Aygün
- Institute of Health Sciences, Social Pediatrics PhD Program, Marmara University, Istanbul, Turkey.
| | - Belma Haliloğlu
- Department of Pediatrics, Division of Pediatric Endocrinology, Marmara University School of Medicine, Istanbul, Turkey.
| | - Tuğba Gökçe
- Department of Pediatrics, Division of Pediatric Endocrinology, Koç University School of Medicine, Istanbul, Turkey.
| | - Ecem Can
- Department of Pediatrics, Division of Pediatric Endocrinology, Koç University School of Medicine, Istanbul, Turkey.
| | - Elif Eviz
- Department of Pediatrics, Division of Pediatric Endocrinology, Koç University School of Medicine, Istanbul, Turkey.
| | - Neslihan Gökmen İnan
- College of Engineering, Department of Computer Engineering, Koc University, Istanbul, Turkey.
| | - Gül Yeşiltepe Mutlu
- Department of Pediatrics, Division of Pediatric Endocrinology, Koç University School of Medicine, Istanbul, Turkey.
| | - Abdullah Bereket
- Department of Pediatrics, Division of Pediatric Endocrinology, Marmara University School of Medicine, Istanbul, Turkey.
| | - Şükrü Hatun
- Department of Pediatrics, Division of Pediatric Endocrinology, Koç University School of Medicine, Istanbul, Turkey.
| |
Collapse
|
3
|
Wu N, Jamnik VK, Koehle MS, Guan Y, Li Y, Kaufman K, Warburton DER. Associations between Sleep Characteristics and Cardiovascular Risk Factors in Adolescents Living with Type 1 Diabetes. J Clin Med 2022; 11:jcm11185295. [PMID: 36142941 PMCID: PMC9503476 DOI: 10.3390/jcm11185295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022] Open
Abstract
Adolescents living with type 1 diabetes (T1D) have an increased risk of developing cardiovascular disease. Sleep patterns have physiological and behavioral impacts on diabetes outcomes. This study aimed to investigate the associations between sleep patterns and CVD risk factors in adolescents living with T1D and their peers living without T1D. This cross-sectional study assessed CVD risk factors and sleep characteristics (and their associations) in adolescents, aged 12–18 years, living with T1D (n = 48) and their peers (n = 19) without T1D. Outcomes included blood pressure, lipid profiles, and sleep characteristics (accelerometry). Statistical differences between groups were determined with chi-square or independent samples t-tests. The associations between sleep characteristics and CVD risk factors were assessed with multivariate linear regression analyses. We found no significant differences between the two groups in terms of sleep duration, efficiency, sleep onset and offset, and frequency of awakenings, and there were associations between sleep efficiency and LDL-C (β = −0.045, p = 0.018, model R2 = 0.230) and triglycerides (β = −0.027, p = 0.012, model R2 = 0.222) after adjusting confounders (diabetes status, sex, age, pubertal stage) in all participants. In conclusion, adolescents with T1D and without T1D sleep less than the recommended eight hours per night. The associations between sleep efficiency and LDL-C and triglycerides are independent of sleep duration, regardless of sex, age, and pubertal stage.
Collapse
Affiliation(s)
- Nana Wu
- Physical Activity Promotion and Chronic Disease Prevention Unit, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Veronica K. Jamnik
- School of Kinesiology and Health Science, York University, Toronto, ON M3J 1P3, Canada
| | - Michael S. Koehle
- Division of Sports Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- School of Kinesiology, Faculty of Education, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Yanfei Guan
- Physical Activity Promotion and Chronic Disease Prevention Unit, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Yongfeng Li
- College of Sports and Health, Shandong Sport University, Jinan 250102, China
| | - Kai Kaufman
- Physical Activity Promotion and Chronic Disease Prevention Unit, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Darren E. R. Warburton
- Physical Activity Promotion and Chronic Disease Prevention Unit, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Correspondence:
| |
Collapse
|
4
|
Ciężki S, Kurpiewska E, Bossowski A, Głowińska-Olszewska B. Multi-Faceted Influence of Obesity on Type 1 Diabetes in Children - From Disease Pathogenesis to Complications. Front Endocrinol (Lausanne) 2022; 13:890833. [PMID: 35784568 PMCID: PMC9243381 DOI: 10.3389/fendo.2022.890833] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/13/2022] [Indexed: 01/08/2023] Open
Abstract
The prevalence of overweight and obesity among youth patients with diabetes type 1 is increasing. It is estimated, that even up to 35% of young patients with this type of diabetes, considered so far to be characteristic for slim figure, are overweight or even obese. General increase of obesity in children's population complicates differential diagnosis of the type of diabetes in youths. Coexistence of obesity has clinical implications for all stages of diabetes course. It is confirmed that obesity is the risk factor for autoimmune diabetes, and is connected with the earlier onset of diabetes in predisposed patients. Many diabetic patients with obesity present additional risk factors for macroangiopathy, and are recognised to present metabolic syndrome, insulin resistance, and typical for diabetes type 2 - polycystic ovary syndrome, or non-alcoholic fatty liver disease. The prevalence of obesity rises dramatically in adolescence of diabetic child, more often in girls. It has negative impact on metabolic control, glycaemic variability and insulin demand. The risk for microangiopathic complications increases as well. The treatment is difficult and includes not only insulinotherapy and non-pharmacological trials. Recently treatment of insulin resistance with biguanids, and treatment with typical for type 2 new diabetes drugs like GLP-1 analogues, SGLT-2 receptor inhibitors, or even cases of bariatric surgery also has been reported.
Collapse
|
5
|
Abstract
PURPOSE OF REVIEW To review the relationship between sleep and hypoglycemia, sleep characteristics, and their associations with glycemic control in persons with type 1 diabetes (T1D). The effects of sleep interventions and diabetes technology on sleep are summarized. RECENT FINDINGS Nocturnal hypoglycemia affects objective and subjective sleep quality and is related to behavioral, psychological, and physiological factors. Sleep disturbances are common, including inadequate sleep, impaired sleep efficiency, poor subjective satisfaction, irregular timing, increased daytime sleepiness, and sleep apnea. Some have a bidirectional relationship with glycemic control. Preliminary evidence supports sleep interventions (e.g., sleep extension and sleep coach) in improving sleep and glycemic control, while diabetes technology use could potentially improve sleep. Hypoglycemia and sleep disturbances are common among persons with T1D. There is a need to develop sleep promotion programs and test their effects on sleep, glucose, and related outcomes (e.g., self-care, psychological health).
Collapse
Affiliation(s)
- Bingqian Zhu
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Ghada Mohammed Abu Irsheed
- College of Nursing, Department of Biobehavioral Nursing Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Pamela Martyn-Nemeth
- College of Nursing, Department of Biobehavioral Nursing Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Sirimon Reutrakul
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Illinois at Chicago, 835 S. Wolcott Ave, Suite 625E, M/C 640, IL, 60612, Chicago, USA.
| |
Collapse
|
6
|
Ji X, Wang Y, Saylor J. Sleep and Type 1 Diabetes Mellitus Management Among Children, Adolescents, and Emerging Young Adults: A Systematic Review. J Pediatr Nurs 2021; 61:245-253. [PMID: 34182231 DOI: 10.1016/j.pedn.2021.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Type 1 diabetes mellitus (T1DM) is one of the most common chronic illnesses among the youth. Emerging evidence has suggested poor sleep as a risk factor for glycemic control. This review aimed to examine the associations between sleep characteristics and diabetes management in children, adolescents, and emerging young adults with T1DM. METHODS Following PRISMA guidelines, the authors searched articles in PubMed, Web of Science, and Scopus from 2000 through August 2020. Using inclusion and exclusion criteria, observational studies and clinical trials that examined sleep and diabetes management among individuals with T1DM (up to 25 years old) were selected for review. RESULTS Twenty-four articles met the review criteria. Most studies did not report differences in self-report sleep between individuals with and without T1DM. However, several studies using objective sleep measures (actigraph and PSG) suggested shorter sleep duration and worse sleep quality in individuals with T1DM. Higher A1C levels and undesirable T1DM self-care behaviors were associated with short and long sleep duration, poor sleep quality, sleep disturbances, and irregular sleep, particularly among adolescent boys, young men and those from immigrant families. Self-care behaviors mediated the associations between sleep and subsequent A1C levels. CONCLUSIONS Too much or too little sleep, poor sleep quality, sleep disturbances and sleep variability are associated with undesirable T1DM management. Although more research is needed, our findings indicate the importance of including sleep education in the plan of care for children, adolescents and emerging young adults with T1DM.
Collapse
Affiliation(s)
- Xiaopeng Ji
- College of Health Sciences, School of Nursing, University of Delaware, DE, USA.
| | - Yiqi Wang
- College of Health Sciences, School of Nursing, University of Delaware, DE, USA; University of Pennsylvania School of Nursing, PA, USA.
| | - Jennifer Saylor
- College of Health Sciences, School of Nursing, University of Delaware, DE, USA.
| |
Collapse
|
7
|
Salah NY, Abido AY, Rashed HR. Relationship of glycaemic derangement using continuous glucose monitoring system with sleep pattern among children with type 1 diabetes. Diabetes Metab Res Rev 2021; 37:e3407. [PMID: 32935448 DOI: 10.1002/dmrr.3407] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/25/2020] [Accepted: 08/24/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Glycaemic derangement has been linked to sleep disruption. However, the impact of glycaemic derangement on sleep pattern among children with type 1 diabetes (C-T1D) remains unraveled. AIM To assess the effect of nocturnal hyperglycaemia and clinically significant (CS) hypoglycaemia on sleep pattern among C-T1D. METHODOLOGY Thirty C-T1D were compared to 30 age and sex matched healthy siblings. Patients having other organ disease that might cause sleep disorders or on medications causing sleep disturbance were excluded. History included diabetes-duration, type and dose of insulin therapy, chronic diabetic-complications, and manifestations of sleep disorders. Epworth Sleepiness Scale-Child Adolescent was used. Continuous glucose monitoring system (CGMS) and overnight polysomnography were done and analysed. RESULTS C-T1D had significantly lower sleep efficiency and significantly higher arousal index (AI), periodic limb movement index and apnoea-hypopnoea index compared to controls. Moreover, they had significantly longer sleep-onset latency, light sleep percentage, and shorter rapid eye movement percentage than controls. According to nocturnal CGMS readings, 15 C-T1D had nocturnal hyperglycaemia (50%), six experienced CS hypoglycaemia (20%), two had level-1 hypoglycaemia (6.7%), and seven were within the normoglycaemic range (23.3%). C-T1D experiencing nocturnal CS hypoglycaemia had significantly higher stage 3 sleep (P = 0.004) than controls. On the other hand, C- T1D experiencing nocturnal hyperglycaemia had significantly higher sleep onset latency (P = 0.013), light sleep percentage (P < 0.001), and AI (P < 0.001) than controls. Nocturnal CS hypoglycaemia was positively correlated to deep sleep duration, while hyperglycaemia was correlated to number of awakenings, sleep-onset latency, and light sleep duration. CONCLUSION In children with T1D CS hypoglycaemia is associated with sleep deepening, while hyperglycaemia is associated with increased light sleep, sleep onset latency.
Collapse
Affiliation(s)
- Nouran Y Salah
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amal Y Abido
- General Practitioner, Health Insurance Hospital, Giza, Egypt
| | - Hebatallah R Rashed
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| |
Collapse
|
8
|
Macaulay GC, Galland BC, Boucher SE, Wiltshire EJ, Haszard JJ, Campbell AJ, Black SM, Smith C, Elder D, Wheeler BJ. Impact of type 1 diabetes mellitus, glucose levels, and glycemic control on sleep in children and adolescents: a case-control study. Sleep 2021; 43:5580781. [PMID: 31583407 DOI: 10.1093/sleep/zsz226] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 07/03/2019] [Indexed: 12/13/2022] Open
Abstract
STUDY OBJECTIVES To assess differences in habitual sleep patterns and sleep states between children and adolescents with type 1 diabetes mellitus (T1DM) and control subjects, and to explore the relationships between sleep, glucose levels, and glycemic control. METHODS Participants included 82 children (5-18 years); 41 with T1DM (cases), and 41 healthy control subjects group matched for age and sex. Sleep was measured by 7-day actigraphy and single-night home-based polysomnography (PSG) recordings. Hemoglobin A1c (HbA1c) and 7 days of continuous glucose monitoring (CGM) data were collected in cases. Regression analyses were used to model all within- and between-group comparisons adjusted for age, sex, and BMI z-scores. RESULTS There were no significant differences in sleep duration, efficiency, or awakenings as measured by actigraphy and PSG between cases and controls, nor sleep states measured by PSG. However, cases had significantly later sleep onset and offset than controls (both p < 0.05), partially moderated by age. Cases with suboptimal glycemic control (HbA1c ≥ 58 mmol/mol [≥7.5%]) had significantly shorter actigraphy-derived total sleep time (TST) (mean difference = -40 minutes; 95% confidence interval = -77, -3), with similar differences in TST measured by PSG. Cases with mean CGM glucose levels ≥10 mmol/L (≥180 mg/dL) on PSG night had significantly more stage N3 (%) sleep and less stage REM (%) sleep (both p < 0.05). CONCLUSIONS Short- and long-term suboptimal glycemic control in T1DM children appears to be associated with sleep alterations. Pediatric diabetes care teams should be aware of potential interrelationships between sleep and T1DM, including management and glycemic control.
Collapse
Affiliation(s)
- Grace C Macaulay
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Barbara C Galland
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Sara E Boucher
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Esko J Wiltshire
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Jillian J Haszard
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Angela J Campbell
- WellSleep Investigation Centre, Department of Medicine, University of Otago, Wellington, New Zealand and
| | - Stephanie M Black
- WellSleep Investigation Centre, Department of Medicine, University of Otago, Wellington, New Zealand and
| | - Claire Smith
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Dawn Elder
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Benjamin J Wheeler
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand.,Paediatric Endocrinology, Southern District Health Board, Dunedin, New Zealand
| |
Collapse
|
9
|
Abdelmaksoud AA, Salah NY, Ali ZM, Rashed HR, Abido AY. Disturbed sleep quality and architecture in adolescents with type 1 diabetes mellitus: Relation to glycemic control, vascular complications and insulin sensitivity. Diabetes Res Clin Pract 2021; 174:108774. [PMID: 33745994 DOI: 10.1016/j.diabres.2021.108774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Insufficient sleep duration and poor sleep quality have been linked to insulin resistance and impaired glucose metabolism. However, the relation between sleep disruption and type1 diabetes (T1D) hasn't been thoroughly explored. AIM To study the association between sleep parameters and glycemic control, insulin resistance and micro-vascular complications among adolescent with T1D. METHODOLOGY Sixty adolescents with T1D were compared to 60 matched controls. Diabetes-duration, insulin-therapy, fundus, Epworth Sleepiness Scale-Child Adolescent and the neuropathy disability score were assessed. Fasting lipids, fraction-C of glycosylated hemoglobin(HbA1c) and urinary albumin-excretion were measured with calculation of the insulin sensitivity score(ISS). Overnight polysomnography(PSG) was done. RESULTS Adolescents with T1D had significantly lower sleep efficiency and rapid eye movement(REM) sleep than controls with significantly higher sleep onset latency, non-REM sleep and arousal index(P < 0.001). Although ISS was negatively correlated to total sleep time(P = 0.002); it was positively correlated to sleep efficiency(P < 0.001). HbA1C was negatively correlated to sleep efficiency(<0.001) and REM sleep(P = 0.003) and positively correlated to sleep onset latency(P = 0.005). T1D adolescents with micro-vascular complications had significantly lower sleep efficiency and REM sleep than those without micro-vascular complications. CONCLUSION Poor sleep quality and architecture among adolescents with T1D are associated with impaired glycemic control, insulin resistance and micro-vascular complications.
Collapse
Affiliation(s)
- Abeer A Abdelmaksoud
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Nouran Y Salah
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Zeinab M Ali
- Department of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hebatallah R Rashed
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amal Y Abido
- Department of Pediatrics, Health Insurance Hospital, 6(th) of October, Giza, Egypt
| |
Collapse
|
10
|
Elrokhsi SH, Bluez GP, Chin CN, Wheeler MD, Silva GE, Perfect MM. Differences in sleep architecture according to body mass index in children with type 1 diabetes. Pediatr Diabetes 2020; 21:98-105. [PMID: 31498940 DOI: 10.1111/pedi.12918] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/16/2019] [Accepted: 06/18/2019] [Indexed: 02/01/2023] Open
Abstract
Slow wave sleep (SWS), or deep sleep, is thought to be the most restorative stage of sleep and may be of a particular interest in the pathophysiology of obesity. The aim of this study was to investigate differences in sleep architecture based on body mass index (BMI) among a pediatric population with type 1 diabetes mellitus (T1DM). We hypothesized that children with T1DM who are obese would have less SWS than those who are not obese. Of 105 children with T1DM (mean age 13.54 years, 49.5% females) in this study, 19% were obese, 22% were overweight, and 59% had a normal BMI (81% non-obese). The overall SWS% among the participants was 13.2%. In contrast to our hypothesis, there was no significant difference in SWS% between obese and non-obese participants. However, the percent of time spent in rapid eye movement (REM) sleep among obese participants was significantly lower than those who were not obese (P = .022), which remained after adjusting the result for multiple covariates. While we found no significant association between the SWS time and BMI, obese adolescents with T1DM spent less time in REM sleep than those who were not obese. This study adds to the growing body of evidence supporting the importance of addressing sleep in clinical care of youth with T1DM.
Collapse
Affiliation(s)
- Salaheddin H Elrokhsi
- Pediatric Endocrinology Division, Banner-University Medical Center, University of Arizona, Tucson, Arizona
| | - Grai P Bluez
- Disability and Psychoeducational Studies, University of Arizona, Tucson, Arizona
| | - Cindy N Chin
- Pediatric Endocrinology Division, Banner-University Medical Center, University of Arizona, Tucson, Arizona
| | - Mark D Wheeler
- Pediatric Endocrinology Division, Banner-University Medical Center, University of Arizona, Tucson, Arizona
| | | | - Michelle M Perfect
- Disability and Psychoeducational Studies, University of Arizona, Tucson, Arizona
| |
Collapse
|
11
|
Perfect MM. Sleep-related disorders in patients with type 1 diabetes mellitus: current insights. Nat Sci Sleep 2020; 12:101-123. [PMID: 32104119 PMCID: PMC7023878 DOI: 10.2147/nss.s152555] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 01/21/2019] [Indexed: 12/11/2022] Open
Abstract
Type 1 diabetes mellitus (T1DM) is an autoimmune condition that results from destruction of beta cells in the pancreas. Several reviews have concluded that sleep contributes to poor glycemic control, diabetes management, and diabetes-related complications in individuals with T1DM and represents an untapped opportunity for intervention. However, at the current juncture, the American Diabetes Association's Standards of Medical Care are devoid of recommendations about how to address sleep in the management of T1DM. This article summarizes reviews of sleep in youth and adults with T1DM and empirical studies that have examined various sleep parameters ranging from sleep disturbances (general, perceived sleep quality, sleepiness, awakenings, and sleep efficiency), sleep duration, sleep consistency, sleep-disordered breathing (SDB), and sleep architecture. The data show that many individuals with T1DM sleep less than recommendations; individuals with the poorest sleep have difficulties with diabetes management; and sleep deficiency including SDB often corresponds to several disease morbidities (neuropathy, nephropathy, etc). Mixed findings exist regarding direct associations of various sleep parameters and glycemic control. SDB appears to be just as prevalent, if not more, than other conditions that have been recommended for universal screening in individuals with T1DM. The article concludes with recommendations for collaborative research efforts to further elucidate the role of sleep in diabetes-related outcomes; investigations to test behavioral strategies to increase sleep quantity and consistency; and considerations for clinical care to address sleep.
Collapse
Affiliation(s)
- Michelle M Perfect
- Department of Disability and Psychoeducational Studies, University of Arizona, Tucson, AZ, USA
| |
Collapse
|